title: Improving antibiotic use in the hospital: Focusing on positive blood cultures is an effective option.
abstract: OBJECTIVE
  The unsolicited and systematic evaluation of positive blood cultures (pBC) after laboratory report by a single infectious disease specialist (IDS) was evaluated during one year, using a computer-generated alert by the laboratory. The main objectives of IDS counselling were to improve antibiotic use for bloodstream infection (i.e., initiating or modifying therapy) and to stop unjustified therapy for contaminated pBC.
  
  
  METHODS
  During the first part of the study (4 months), all pBC in patients from ICUs, medical and surgical wards were analyzed. After an interim analysis, only pBC from medical and surgical wards were evaluated during the second part (8 months).
  
  
  RESULTS
  Overall, 1090 episodes of pBC (representing 866 patients) were evaluated and classified as bloodstream infection (65.5%), contamination (29%) or undetermined (5.5%). Forty-three percent of episodes prompted IDS counselling, including initiation (5%), modification (27.5%), withdrawal (3.5%) and diagnosis workup (5%). Restricting the evaluation to medical and surgical wards increased the rate of counselling (61.2% vs. 27.7%, P<0.0001), notably for de-escalating (20% vs. 8%, P<0.0001), initiating (9% vs. 2%, P<0.0001), oral switch (6% vs. 2%, P<0.0001), withdrawing (5% vs. 2%, P=0.002) or reducing the duration of therapy (5% vs. 2%, P=0.002).
  
  
  CONCLUSIONS
  In complement to the laboratory report, a computer-generated alert used by the IDS was useful for the management of pBC in hospital. The impact of IDS counselling was more effective when the evaluation was restricted to medical and surgical wards.
authors.affiliation: Université Paris 12, Assistance publique-Hôpitaux de Paris, groupe hospitalier Albert-Chenevier-Henri-Mondor, unité de contrôle, épidémiologie et prévention de l'infection, 94010 Créteil cedex, France. philippe.lesprit@hmn.aphp.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesprit
authors.forename: Lilia
authors.initials: L
authors.lastname: Merabet
authors.forename: José
authors.initials: J
authors.lastname: Fernandez
authors.forename: Patrick
authors.initials: P
authors.lastname: Legrand
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy*; D001769:Blood / Q000382:microbiology*; D001800:Blood Specimen Collection; D003195:Computer Communication Networks; D004363:Drug Utilization; D004866:Equipment Contamination; D005189:False Positive Reactions; D019983:Guideline Adherence; D006748:Hospital Departments / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D057970:Inappropriate Prescribing; D055552:Infectious Disease Medicine / Q000458:organization & administration*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D007388:Internal Medicine; D007755:Laboratories, Hospital / Q000458:organization & administration; D008485:Medical Audit; D050316:Medical Order Entry Systems; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents